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Meaningful engagement of people living with HIV who use drugs: methodology for the design of a Peer Research Associate (PRA) hiring model

Community-based HIV, harm reduction, and addiction research increasingly involve members of affected communities as Peer Research Associates (PRAs)—individuals with common experiences to the participant population (e.g. people who use drugs, people living with HIV [PLHIV]). However, there is a paucity of literature detailing the operationalization of PRA hiring and thus limited understanding regarding how affected communities can be meaningfully involved through low-barrier engagement in paid positions within community-based participatory research (CBPR) projects. We aim to address this gap by describing a low-threshold PRA hiring process. Results In 2012, the BC Centre for Excellence in HIV/AIDS and the Dr. Peter AIDS Foundation collaborated to develop a mixed-method CBPR project evaluating the effectiveness of the Dr. Peter Centre (DPC)—an integrative HIV care facility in Vancouver, Canada. A primary objective of the study was to assess the impact of DPC services among clients who have a history of illicit drug use. In keeping with CBPR principles, affected populations, community-based organizations, and key stakeholders guided the development and dissemination of a low-barrier PRA hiring process to meaningfully engage affected communities (e.g. PLHIV who have a history of illicit drug use) in all aspects of the research project. The hiring model was implemented in a number of stages, including (1) the establishment of a hiring team; (2) the development and dissemination of the job posting; (3) interviewing applicants; and (4) the selection of participants. The hiring model presented in this paper demonstrates the benefits of hiring vulnerable PLHIV who use drugs as PRAs in community-based research. Conclusions The provision of low-barrier access to meaningful research employment described herein attempts to engage affected communities beyond tokenistic involvement in research. Our hiring model was successful at engaging five PRAs over a 2-year period and fostered opportunities for future paid employment or volunteer opportunities through ongoing collaboration between PRAs and a diverse range of stakeholders working in HIV/AIDS and addictions. Additionally, this model has the potential to be used across a range of studies and community-based settings interested in meaningfully engaging communities in all stages of the research process.Non UBCMedicine, Faculty ofReviewedFacult

An integrated approach to care attracts people living with HIV who use illicit drugs in an urban centre with a concentrated HIV epidemic

Abstract Background People living with HIV (PLHIV) who are also marginalized by social and structural inequities often face barriers to accessing and adhering to HIV treatment and care. The Dr. Peter Centre (DPC) is a non-profit integrated care facility with a supervised injection room that serves PLHIV experiencing multiple barriers to social and health services in Vancouver, Canada. This study examines whether the DPC is successful in drawing in PLHIV with complex health issues, including addiction. Methods Using data collected by the Longitudinal Investigations into Supportive and Ancillary health services (LISA) study from July 2007 to January 2010, linked with clinical variables available through the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program, we identified DPC and non-DPC clients with a history of injection drug use. Bivariable and multivariable logistic regression analyses compared socio-demographic and clinical characteristics of DPC clients (n = 76) and non-DPC clients (n = 482) with a history of injection drug use. Results Of the 917 LISA participants included within this analysis, 100 (10.9%) reported being a DPC client, of which 76 reported a history of injection drug use. Adjusted results found that compared to non-DPC clients with a history of injection drug use, DPC-clients were more likely to be male (AOR: 4.18, 95% CI = 2.09–8.37); use supportive services daily vs. less than daily (AOR: 3.16, 95% CI = 1.79–5.61); to have been diagnosed with a mental health disorder (AOR: 2.11; 95% CI: 1.12–3.99); to have a history of interpersonal violence (AOR: 2.76; 95% CI: 1.23–6.19); and to have ever experienced ART interruption longer than 1 year (AOR: 2.39; 95% CI: 1.38–4.15). Conclusions Our analyses suggest that the DPC operating care model engages PLHIV with complex care needs, highlighting that integrated care facilities are needed to support the multiple intersecting vulnerabilities faced by PLHIV with a history of injection drug use living within urban centres in North America and beyond

Geo-Archeological Mapping Using Very High Resolution and Stereoscopic Satellite Imagery (Russian TK-350) Integrated in a GIS. A Case Study for the Wadi Mujib Area near Lehun (Jordan)

A geo-archeological model based on various environmental factors was developed for the Wadi Mujib area near the site of Lehun (Jordan). A DEM and a lithological map based on respectively a topographical and a geological map were prepared and integrated into a GIS. Since the geomorphology of the area is of primary importance to archeological site prediction an inventory of relevant relief information was extracted from a geomorphological map based on very high resolution and stereoscopie Russian TK-350 images. These images offer an interresting alternative for conventional stereoscopic aerial photographs on scale 1:50,000 or smaller, due to the high quality, the easy image processing, the large covered area, the availability and the sure and quick delivery. After integration of the scanned geomorphological map the GIS finally comprised eight factor layers. A simple addition of these information layers resulted in a probability map for geo-archaeology showing the spatial variance of the probability for archaeological evidence in the area. In the frame of the construction of a dam on the Wadi Mujib near the King's Highway the archaeologists can use this map as a tool for organizing rescue research in a quick and efficient way

An integrated approach to care attracts people living with HIV who use illicit drugs in an urban centre with a concentrated HIV epidemic

Background: People living with HIV (PLHIV) who are also marginalized by social and structural inequities often face barriers to accessing and adhering to HIV treatment and care. The Dr. Peter Centre (DPC) is a non-profit integrated care facility with a supervised injection room that serves PLHIV experiencing multiple barriers to social and health services in Vancouver, Canada. This study examines whether the DPC is successful in drawing in PLHIV with complex health issues, including addiction. Methods: Using data collected by the Longitudinal Investigations into Supportive and Ancillary health services (LISA) study from July 2007 to January 2010, linked with clinical variables available through the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program, we identified DPC and non-DPC clients with a history of injection drug use. Bivariable and multivariable logistic regression analyses compared socio-demographic and clinical characteristics of DPC clients (n = 76) and non-DPC clients (n = 482) with a history of injection drug use. Results: Of the 917 LISA participants included within this analysis, 100 (10.9%) reported being a DPC client, of which 76 reported a history of injection drug use. Adjusted results found that compared to non-DPC clients with a history of injection drug use, DPC-clients were more likely to be male (AOR: 4.18, 95% CI = 2.09–8.37); use supportive services daily vs. less than daily (AOR: 3.16, 95% CI = 1.79–5.61); to have been diagnosed with a mental health disorder (AOR: 2.11; 95% CI: 1.12–3.99); to have a history of interpersonal violence (AOR: 2.76; 95% CI: 1.23–6.19); and to have ever experienced ART interruption longer than 1 year (AOR: 2.39; 95% CI: 1.38–4.15). Conclusions: Our analyses suggest that the DPC operating care model engages PLHIV with complex care needs, highlighting that integrated care facilities are needed to support the multiple intersecting vulnerabilities faced by PLHIV with a history of injection drug use living within urban centres in North America and beyond.Other UBCNon UBCReviewedFacult

Positive Strategies to Enhance Problem-Solving Skills (STEPS): A Pilot Randomized, Controlled Trial of a Multicomponent, Technology-Enhanced, Customizable Antiretroviral Adherence Intervention for HIV-Infected Adolescents and Young Adults

Adolescents are disproportionately impacted by HIV in the United States. Optimal effects from antiretroviral therapy (ART) can be achieved through stringent adherence to a daily medication regimen; for adolescents, this may be interrupted due to complex barriers unique to this age group. We previously conducted formative qualitative interviews with HIV-infected adolescents to identify key barriers facing adolescents regarding ART adherence and potential strategies to address these barriers. These data were used to inform an ART adherence intervention designed to overcome difficulties unique to HIV-infected adolescents (e.g., internalized stigma and HIV-related shame, disclosure to sexual partners, social life, and extracurricular activities at school, etc.). The resulting intervention—“Positive Strategies To Enhance Problem-solving Skills (Positive STEPS)”—combines five individual counseling sessions with daily text message reminders. We conducted a pilot randomized controlled trial of the intervention against a standard of care control and report on the feasibility of procedures and participant acceptability of the intervention in terms of content, structure, and format. ART adherence was measured in both arms through Medication Event Monitoring System pill caps and self-report. Feasibility and acceptability of the Positive STEPS intervention was evidenced by 90% retention for the intervention sessions; 100% completion of the four-month assessment; and positive responses on postintervention evaluation forms (all intervention participants rated Positive STEPS as “acceptable” or “very acceptable”) and brief exit interviews. At the 4-month assessment visit, the change in ART adherence among the intervention group [mean change score = 13%, standard deviation (SD) = 29.5] was significantly higher compared with the standard of care group (mean change score = −26%, SD = 26.0; Cohen's d effect size = 1.43, confidence interval = 0.17–2.49, p  = 0.02). Future testing of the intervention in a fully powered randomized controlled trial to determine efficacy is warranted